| NPI | 1689795593 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DZON MANH NGUYEN President 435-557-6453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA DE00008773) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: WA DE00008172) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-08-22 |